How Could Inhaled Dust and IV Drug Use Be Confused At Autopsy?

James Zadroga gave his name to the 9/11 healthcare act currently under debate in the Senate, and many feel he sacrificed his life for his country. But what is the science behind the dispute over his cause of death?

Arrows point to crystals in the lungs of an IV drug user.
[Image credit: granuloma.homestead.com]

In late 2001, 29 year-old police detective James Zadroga logged hundreds of hours volunteering at the cleanup of the World Trade Center site. Five years later, he wheezed his last breath.

In 2007, the City of New York claimed the lung disease that killed James Zadroga was not caused by toxic dust particles from the towers, but by injection of crushed prescription painkillers, such as oxycontin. Two other autopsies have been conducted, both contradicting the NYC medical examiner, and asserting 9/11 dust was the cause of death. Apparently distinguishing between the two is not so straightforward, even for experienced pathologists.

But how can drug use and dust inhalation be confused?

It turns out fillers used in pills – primarily talc and cellulose – don’t fully dissolve in water. If injected, insoluble particulates tend to collect in tiny blood vessels surrounding the lungs. The body attempts to wall off these particles by creating what are known as granulomas. Granulomas can cause inflammation, which eventually impairs breathing and ultimately strains the heart.

Foreign body granulomas are actually common among intravenous drug users. Medical professionals can tell the difference between particles from injected drugs and inhaled dust by looking at where the granulomas are found. In drug users they form in the capillaries, while in dust inhalers they form in the lung tissue itself. But to allow oxygen transport into the blood, the interface between blood vessels and the tiniest branches of the lung, the alveoli, is extremely thin. Perhaps this is why, on a microscope slide, it isn’t always so easy to tell on which side a foreign body was originally deposited.

In an interview, the city medical examiner says he found foreign particles in the capillaries surrounding Zadroga’s lungs. He did not observe glass particles in the lung tissue, as claimed in a subsequent autopsy by the chief forensic pathologist of the New York State Police.

James Zadroga’s death has been so closely scrutinized because of the legislation that bears his name. The James Zadroga 9/11 Healthcare Compensation Act will come before the Senate this week. It allocates 7.4 billion dollars to address long-term healthcare needs of first responders, residents and office workers who suffer effects of exposure to WTC toxins. The act also compensates families of those whose deaths are attributed to post-9/11 environmental exposures.

It is unclear what the burden of proof will be for those who may have been exposed to toxins and irritants at Ground Zero. There are certainly convincing cases involving inhaled foreign particles, including carbon nanotubes matching WTC dust, found in lung tissue of people present at the disaster site.

The Zadroga Act passed in the House in September. If it can gather one more Republican vote, it is expected to pass the Senate, and be signed by President Obama. Regardless of the dispute over his cause of death, Zadroga’s service and sacrifice are undeniable.